La césarienne . ard centre. Le montant de l'hémorragie est généralement pas excessive et est facilement con-contrôlés. Il y a toujours un danger de blesser la vessie et ofopening la cavité péritonéale, mais si la dissection est effectuée avec careneither de ces accidents se produisent. Au cours de la séparation de l'thebladder l'uretère gauche et l'artère utérine sont visibles dans la plupart des cas et, par conséquent, devrait être à l'abri de blessures, mais l'inattention peut entraîner dés-astrously. L'emploi de la position de Trendelenburg pendant theoperation est presque indispensable. L'opération peut être effectuée dans l'i6o se césarienne

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Cesarean section . ard center. The amount of hemorrhage is usually not excessive and is easily con-trolled. There is always some danger of injuring the bladder and ofopening the peritoneal cavity, but if the dissection is made with careneither of these accidents should occur. During the separation of thebladder the left ureter and uterine artery are visible in most cases and, therefore, should be safe from injury, but carelessness may result dis-astrously. The employment of the Trendelenburg position during theoperation is almost imperative. The operation can be performed in the i6o CESAREAN SECTION ordinary dorsal position, but the difficulties are so much Increased thatneither the operator nor the patient has a fair chance. This operation is probably the best of the extraperitoneal methods, and in cases in which the propriety of the classical method is doubtful itmay often prove of value, but it has certain definite disadvantages. Itshould not be substituted for the conservative operation in clean cases. Fig. 2>1-—Kustners Operation.Incision in uterus low down. and should be undertaken only by well trained surgeons; second, thebladder is sometimes injured, even in trained hands; third, the woundmust always be drained, and if infection occurs, the patient must undergoa prolonged suppurative process, to which she may succumb, or as aresult of which she may be invalided for a long time; and fourth, theextensive adhesions which result make its repetition impossible in sub-sequent labors. It is, therefore, an operation only to be done when therisks of the classical operation seem too great and yet the patient is notfrankly infected with a virulent organism. Its employment in proper EXTRA- AND TRANSPERITONEAL CESAREAN SECTIONS i6i cases may result in limitation of the number of cases in which pubiotomyis recommended as a substitute for a late cesarean section. Latzkos Operation.—Although Kiistners technic seems to me tooffer the best chance of reaching the lower ut

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